Your daily Selection of IRIN Africa PlusNews reports, 4/15/2005

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CONTENT:

1 - AFRICA: New thinking needed to counter AIDS in rural communities

2 - ETHIOPIA: Serious challenges facing HIV/AIDS fight - US report

3 - GHANA: HIV-AIDS on decline for first time in 5 years, survey shows

1 - AFRICA: New thinking needed to counter AIDS in rural communities

DURBAN, 15 April (PLUSNEWS) - The link between HIV/AIDS and hunger in rural

communities has received a great deal of attention over the past few years -

particularly in Southern Africa, where HIV/AIDS has added a new dimension to the

recent food crisis.

But research emerging from this week's international conference on 'HIV/AIDS and

Food and Nutrition Security' in Durban, South Africa, showed that very little is

know about the actual impact of the pandemic on rural communities.

The three-day conference, organised by the Washington-based International Food

Policy Research Institute (IFPRI), brings together policymakers, donors and

researchers to develop strategies for improving and expanding the response to

HIV/AIDS and food security.

In his keynote address on Thursday, Dr Tony Barnett from the London School of

Economics warned against the danger of demanding action when there was only

" spotty and patchy evidence " about what was happening in farming systems.

Barnett raised questions that " fly in the face of conventional wisdom " on " what

we think we know " about HIV/AIDS and food and nutrition security.

According to Stuart Gillespie, conference director and senior research fellow at

IFPRI, researchers attending the conference were taking " a critical look at

existing evidence " , and finding that " while some of the research supports

conventional wisdom about the massive impact of HIV/AIDS on livelihoods, more

research put on the table [this week] is forcing us to change the way we look at

things. "

" We're seeing that HIV/AIDS is intertwined with multiple vulnerabilities, and we

have to avoid AIDS exceptionalism ... it's a complex issue that looks different

in different places, " he told PlusNews.

As an example, Barnett mentioned three studies he conducted in a small village

in the Rakai district of Uganda, examining the effects of HIV/AIDS on farming

communities from 1989 to 2004.

Contrary to expectations, and despite an HIV prevalence of 8 percent in 1993,

the farming system had not collapsed from the strain of AIDS-related illnesses,

and all the study respondents from 1993 were still alive.

The region's " fairly robust and very resilient farming systems " , sustained by

good soils and " high ... rainfall " , had created a buffer against the impact of

HIV/AIDS.

This was not a " devastated community " , but the situation was not the same

everywhere, and there was a need for more research and a greater diversity of

responses.

Barnett called for large-scale donor and state-driven efforts that recognised

the complex nuances in the impact of HIV/AIDS on rural households. He admitted

that this would be difficult for governments, but stressed that " one size will

not fit all " .

Previous assumptions during the early stages of the pandemic - that HIV/AIDS

impacted wealthy, more educated people - were no longer valid, as poorer

households were now more affected. But policies and programmes were not changing

as quickly as the virus was progressing, and rural households remained

neglected.

Labour technologies used in rural communities would also need to keep pace with

the epidemic, he warned, as some were no longer appropriate.

" The problem is: how can we introduce innovations at a time when people are not

living long enough to adopt to the innovations - is there enough time for

communities to adapt to these changes; is there existing and appropriate

technology which will work in these changed circumstances? " he asked.

While the benefit of antiretroviral (ARVs) medication was that it increased

lifespans by between 5 and 10 years, this was still not being fully exploited.

" The problem is, we don't know what to do - this is a novel situation, and the

response must be rapid ... [but we] don't know what works, " Barnett said.

With the danger of drug resistant strains of the virus developing during this

window, African countries had to ensure that ARVs were used regularly, and

continued access to the treatment was available.

He expressed concern that large pharmaceutical companies, already feeling the

pinch from dramatic ARV price cuts, would not respond rapidly to the need for a

new generation of cheaper medicines for developing countries.

" We are in perilous waters, " he declared.

Making matters worse, rural households still had a problem accessing treatment,

while widespread stigma remained prevalent in small communities. Under these

circumstances, " how long will it be before we see a new epidemic of resistant

HIV in rural areas? " Barnett wondered.

He cautioned that " bureaucratic inertia " , and using " yesterday's solutions for

today's problems " would do more harm than good.

Current prevention methods had not provided all the answers; more research into

the use of microbicides as a female-controlled prevention method was needed.

" The history of prevention shows us the mistakes we've made ... it cannot be

business as usual, " Barnett concluded.

[ENDS]

2 - ETHIOPIA: Serious challenges facing HIV/AIDS fight - US report

ADDIS ABABA, 15 April (PLUSNEWS) - Ethiopia is facing serious challenges in

overcoming its HIV/AIDS epidemic, according to a report released by the US

President's Emergency Plan for AIDS Relief (PEPFAR) in the capital, Addis Ababa,

on Wednesday.

" The key challenge is to help men and women move beyond pervasive stigma and

denial, " said the brief - a first-year progress report for the five-year

strategy, launched in Ethiopia in 2004.

In addition to entrenched stigma and discrimination, poor health care access and

a lack of water and electricity in some areas were listed as key constraints.

Snipe, PEPFAR's Ethiopia coordinator, told IRIN: " With 1.6 million

infected - making Ethiopia fifth in the world in the number of people infected

with HIV - Ethiopia has a serious problem.

" We are committed to Ethiopia in supporting those who are not only infected but

affected by HIV as well, " he added.

Wednesday's report also noted that women remained particularly vulnerable with

" social and cultural institutions " accepting sexual violence, which increased

infections rates.

A separate progress report, presented to the US congress last month by the

country's global AIDS coordinator, Randall Tobias, said Ethiopia was a long way

from meeting key targets.

Tobias's report stated that 30,000 Ethiopians infected or affected by HIV/AIDS

were receiving care and treatment. By 2008, PEPFAR hoped that one million people

would be receiving support.

It added that, one year after PEPFAR was launched, some 15,000 orphans were

receiving help, which the US hoped to expand to half a million by 2008.

Only 9,500 Ethiopians, it went on, were receiving life-prolonging antiretroviral

drugs - 5 percent of those who needed them. This meant the country ranked third

from bottom out of the 15 countries targeted by PEPFAR.

US officials at the launch of the report were unable to say which 2004 targets

had been met, as they were still compiling the data. Aurelia Brazeal, the US

ambassador to Ethiopia, said that despite the massive impact of the virus,

Ethiopia was making inroads.

" HIV/AIDS is one of the world's greatest but saddest challenges - a challenge

that is our responsibility and obligation to meet, " she told experts at the

launch.

Snipe said that America spent $43 million in Ethiopia in 2004 to fight the

continuing spread of the virus. A further $61 million was earmarked for this

year - half of which will pay for antiretroviral drugs, he added.

Statistics released by the Ethiopian government at the beginning of 2005 showed

that the HIV prevalence rate in urban areas has reached a plateau. Some 900,000

people have died from AIDS-related illnesses since 1986.

That figure would rise to 1.8 million by 2008 if current trends continued, the

government predicted. Mortality rates among teachers, for example, had already

risen by 5 percent. Life expectancy had been cut by five years to 46 because of

HIV, it said.

[ENDS]

3 - GHANA: HIV-AIDS on decline for first time in 5 years, survey shows

ACCRA, 15 April (PLUSNEWS) - Ghana's HIV/AIDS infection rate has dropped for the

first time in five years, and is now down countrywide to 3.1 percent from 3.6

percent in 2003, according to a new sentinel survey released this week.

But officials in Ghana, whose population of 20 million has one of the lowest HIV

rates in West Africa, remain concerned by big regional differences and

increasing signs of unprotected sex among youths.

The survey shows a fall in HIV infection rates in 14 of the 35 areas registered.

In the south, Ghana's most populous area and the one hardest hit by the

pandemic, six sentinel sites had a prevalence rate of five percent, against

eight sites in 2003.

" I think our behavioural change strategies might be beginning to pay off, " Sakyi

Awuku Amoa, director-general of the Ghana AIDS Commission (GAC), told PlusNews.

" But for the moment, I do not want to over-emphasise our achievements. "

" I hope these recent figures will allow us to channel our strategies into the

right interventions to enable us to achieve a three-year significant drop in our

prevalence rates, " Amoa added.

Between September and December 2004, 15,711 blood tests were analysed in 35

sentinel sites country-wide from pregnant women attending ante-natal clinics as

well as patients seeking treatment for Sexually Transmitted Diseases (STD).

In southern Ghana, prevalence rates vary from three to 6.5 percent while in the

northern areas, which have been less affected by the epidemic, there was an

average prevalence rate of 1.8 percent.

Areas with a concentration of travellers, transporters and businessmen recorded

prevalence rates as high as six percent. In Ho, the capital of the eastern Volta

region bordering Togo in the east, 5.8 percent of people tested are HIV

positive, and Tema, Ghana's main harbour city, 20 km from the capital Accra,

recorded 6.4 percent.

In the western region on the border with Cote d'Ivoire, prevalence rates reached

6.8 percent in the towns of Wenchi and Fanteakwa, the highest HIV rates recorded

in rural areas.

In the eastern region, the sentinel site in the regional capital Koforidua

registered 5.4 percent while Agomanya had 7.4 percent, the country's highest

prevalence rate, but less than 9.2 percent in 2003.

Located near the Akosombo hydroelectric dam, the administrative centre of

Agomanya has always suffered the country's highest HIV infection rate. Farmers

who lost their lands on the creation in the 1960s of Lake Volta, the world's

second largest artificial lake, often migrated while wives worked in hotels and

bars across the region, sometimes becoming sex workers.

Despite the dip in HIV prevalence, authorities responded with caution.

" This drop does not mean HIV infections are coming down in Ghana, " Nii Akwei

Addo, programme manager of the National AIDS Control Programme (NACP), told

PlusNews. " We need a consistent fall over three years. "

" We can only start rejoicing if all the sentinel sites record drops, which

unfortunately was not the case with the 2004 survey, " Akwei Addo added.

Concerns emerged from the survey results over HIV prevalence rates as well as

high levels of syphilis infections among youth, suggesting that increasing

numbers of young people are engaging in unprotected sex.

The survey showed that the age groups 15-19 and 25-29 recorded a slight increase

of 0.1 percent over rates recorded in 2003 to hit a 4.5 percent HIV prevalence

rate in 2004.

AIDS Control Programme officials say these results should be an issue of concern

as they may indicate either high sexual activity or very little impact in

prevention on the two groups.

" We better start thinking of having sentinel sites in schools or places where

concentrations of youths are high, " said Warren Naamara, UNAIDS country

coordinator.

" If we want the figures to go down, we need to go beyond ante-natal clinics and

Sexually Transmitted Infection (STI) sites and go into these large but unknown

populations, " Naamara suggested.

Meanwhile, health officials have given assurances that government will stick to

its HIV treatment targets. Antiretroviral (ARV) drugs are available only in four

hospitals, all located in southern Ghana, but the government plans to extend

them to all 10 regional hospitals in the country by the end of the year.

" It is going to be [difficult] but we have to take up the challenge and stick to

the targets of scaling up this year, " Akwei Addo said. " April will see the

opening of another treatment centre at the Koforidua government hospital " .

According to Ghanaian authorities, about 2,028 people are currently receiving

state subsidised ARVs, out of the 70,000 people who should be on treatment.

In 2004, the Global Fund to Fight AIDS, Tuberculosis and Malaria gave Ghana a

grant of US $15 million over two years for the distribution of ARVs. The

government has planned for a six million dollar budget in 2005 to subsidise ARV

therapy.

[ENDS]

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